July 1st is the medical new year. Medical interns begin their journeys into the real world of clinical medicine, journeys that started during medical school but become much more real when they sign their own orders in a chart. Every year around this time medical bloggers (among others of course) discuss the "July Phenomenon". Today's post is not about the "July Phenomenon", something that may exist in some contexts but is likely dwarfed by other problems in medical education.
Rather than re-hash the debate on whether July in the most dangerous month to be in a hospital (it probably isn't), I'd like to give a little advice to newly minted doctors. The rest of you are welcome to read it too. This applies mainly to internal medicine, but I'm sure much of it crosses over into other specialties.
- Embrace your fear. You have good reason to be scared. You are directly responsible for the lives of others. These others are very sick, or they wouldn't be in a hospital. But remember that you aren't alone. Your colleagues can and will help you, and you can help them. Support each other. And remember that your senior resident and attending physician are there to help you, whether they act like it or not. Never be afraid to ask for help, but when you call, have your information in hand; anticipate questions. If you don't know what to do about a cardiac dysrhythmia, make sure you have an EKG and have ordered some labs before you call the cardiac fellow. It will save you time and embarrassment, and will get the patient help more quickly.
- Listen to the nurses and ancillary staff. They spend much more time with the patient than you do, they've seen many years of interns come and go. They can help you, but if they sense you don't respect them or that you aren't caring for their patients well, they will hurt you. They will do whatever they can to help their patients, and they will not care if they make you miserable in the process. They will often know more than you do. If you don't trust what they tell you, verify it. You do posses a different sort of knowledge, one that you can combine with theirs to help your patients.
- Read up on your cases. You may not have a lot of time for formal reading and studying. Read up on the diseases your own patient has, and soon you will have an impressive breadth and depth of knowledge. Listen on rounds, especially when your colleagues are presenting their patients and you'll get more bang for your buck. Teach the medical students if you have them and you'll learn even more.
- Sleep when you can. Sleepiness harms both you and the patient. I cannot emphasize enough the value of sleep. Go to bed early, nap if you can. If you're too tired to drive home, don't.
- Don't abuse substances other than caffeine. Even caffeine isn't that good, but if you are susceptible to substance abuse, the stress of internship can be dangerous. Be honest with yourself, and if you develop a problem, seek help from your program. You'd be surprised how much help you can get.
- Eat well and exercise. Even if it's only taking the stairs (three down, two up), exercise will help you. You'll need it. Try to avoid all the crappy free food at conferences. Go for the healthy choices at the cafeteria.
- Wash your hands. If a patient asks you if you did, don't be offended. Thank them for the reminder and do it again. If you can, wash them in front of the patient so they can see that you care enough to do it. Remember that certain pathogens, such as C. difficle, sporulate and will not be killed by topical alcohol solutions but must be physically scrubbed off.
- Learn to live with uncertainty. In the hospital you get used to having information at your fingertips. You can order stat labs, get X-rays and other studies quickly. You can't do that in the clinic. Not every patient will present classically. It is more common for an common disease to present uncommonly than an uncommon disease to present commonly. Dig?
- Trust no one. Patients will come up from the ER "pre-packaged", work up done, diagnosis made. Don't believe it. Verify it for yourself. Start from the beginning, because leaning on others' workups simply perpetuates errors.
- Corollary: examine every patient yourself, and do it right. The exam can be focused, but do it. If your resident or student says that the skin is intact, turn the patient over and search for bed sores. Listen to the lungs. Check the mouth for thrush. Be confident in your skills, skills which will improve every day as you use them.
- Senior residents, remember the interns are the interns, not you. Let them do their work. Let them answer their own questions. While they are pre-rounding, do your own pre-rounding, checking labs, checking in on patients. This way, when you pimp the intern on Mr. Smith's potassium and she doesn't know it, your team will realize that not only are you on top of things, but you're watching them, both to help and to make sure they stay on task.
- Wikipedia is not a valid medical reference. I'm sorry I have to even say this.
- Ars longa vita brevis. Enjoy the art. Medicine is interesting. It's fun. And there are no bad patients. It's just as important to learn how to manage a drug-seeking sociopath as it is to treat an acute MI. There is always something to learn, even if that "something" is that you don't want to be a gerontologist.
OK, folks. Go for it.